CHAPTER 14- Infectious Diseases

Question 1

What is the number one infectious disease with the highest mortality worldwide?

1. Tuberculosis
2. Hepatitis B
3. Influenza
4. HIV/AIDS

Answer 1

4. HIV/AIDS

The number one infectious disease with the highest mortality worldwide is HIV/AIDS. In 2013, there were 35 million people living with HIV globally. In the same year, 1.5 million people died from AIDS-associated illnesses.

Question 2

Meningococcal meningitis is a bacterial infection that is spread by:

1. Droplets of respiratory or throat secretions from carriers.
2. Vector-borne transmission.
3. Airborne contact within 20 feet.
4. Non-contact transmission modes.

Answer 2

1. Droplets of respiratory or throat secretions from carriers.

Meningococcal meningitis is a bacterial infection that is spread by droplets of respiratory or throat secretions from carriers.

Question 3

Infected mosquitoes can transmit the following diseases:

1. Lyme disease, tularemia, and cholera.
2. Chikungunya, malaria, and West Nile virus.
3. Yersinia pestis, Rocky Mountain Spotted Fever, and echinococcosis.
4. Cholera, Yersinia pestis, and tularemia.

Answer 3

2. Chikungunya, malaria, and West Nile virus.

Infected mosquitoes can transmit chikungunya, malaria, and West Nile virus. Only malaria has prevention and treatment medications. Prevention measures include using insect repellent, wearing long-sleeve shirts and pants, and using windows and door screens.

Question 4

A 22-year-old female tree worker was bitten by a raccoon that had been acting sluggish and frothing at the mouth. Upon arrival at the primary care office, the initial action of the nurse practitioner would be to:

1. Send the young woman to the hospital Emergency Room.
2. Call the Centers for Disease Control for direction.
3. Report this to the local Department of Public Health.
4. Wash the wound thoroughly with soap and water.

Answer 4

4. Wash the wound thoroughly with soap and water.

In order to prevent infection and to promote optimal wound healing careful inspection and cleansing of wounds is required. Vaccinations for rabies, as well as tetanus, are also needed.

Question 5

After cleaning the wound, the nurse practitioner notes that the raccoon bite has pierced the skin. The nurse practitioner realizes that the patient has never had a rabies vaccine and needs to get a rabies vaccination series started no later than:

1. 48 hours.
2. 72 hours.
3. 36 hours.
4. 24 hours.

Answer 5

4. 24 hours.

Rabies is transmitted by wild animals, with the bat being the most common vehicle in the United States. Vaccinations can begin after 24 hours post-bite; however, the more quickly a person seeks care the more quickly wound cleansing and the prevention of infections can begin, chiefly by starting the vaccination series. Rabies immune globulin should also be administered.

Question 6

Rabies vaccination series for those without prior vaccination are given after rabies immunoglobulin on days:

1. 0, 3, 7, and 14.
2. 0, 5, 12, and 21.
3. 0, 1, 5, and 14.
4. 0, 3, 14, and 21.

Answer 6

1. 0, 3, 7, and 14.

Rabies vaccinations for those who have received a prior series include one dose immediately, followed by a second dose on day 3. No rabies immune globulin is needed.

Question 7

Signs and symptoms of measles (rubeola) include:

1. Koplik’s spots, high fever, cough.
2. Parotitis, low-grade fever, vesicular lesions on the chest.
3. High fever, confusion, and pustular lesions on arms and legs.
4. Koplik’s spots, headaches, and sore throat.

Answer 7

1. Koplik’s spots, high fever, cough.

Signs and symptoms of measles (rubeola) include Koplik’s spots, high fever, cough. These tiny white spots appear in the mouth 2–3 days after symptoms start.

Question 8

A 49-year-old male patient presents to the office upon returning from a trip to the Caribbean. His chief complaint is a high fever of 103°F and a headache. Related to his recent travel, the differential diagnosis will include:

1. Rocky Mountain Spotted Fever, West Nile virus, meningitis.
2. Dengue fever, malaria, and chikungunya.
3. Dengue fever, West Nile virus, and variola.
4. West Nile virus, bubonic plague, and malaria.

Answer 8

2. Dengue fever, malaria, and chikungunya.

All three of these illnesses are mosquito-borne and present with clinical symptoms of fever and headache, among other signs and symptoms. Recent travel to areas with endemic disease is a key factor to be assessed during the history portion of the exam.

Question 9

Bartonella henselae infection is most often caused by:

1. Dog bites.
2. Cat bites.
3. Exposure to cat feces.
4. Bites from rabid bats.

Answer 9

2. Cat bites.

Bartonella bacteria can cause three illnesses in humans, including cat-scratch fever. Trench fever is caused by B. quintana, and Carrión’s disease is caused by B. bacilliformis.

Question 10

Signs and symptoms of Bartonella henselae infection include:

1. Fever, headache, and swollen lymph nodes.
2. Headache, cough, and runny nose.
3. Fever, generalized rash, and cough.
4. Generalized rash, headache, and pharyngitis.

Answer 10

1. Fever, headache, and swollen lymph nodes.

Signs and symptoms of Bartonella henselae infection include fever, headache, and swollen lymph nodes.

Question 11

Treatment of mild Bartonella henselae Infection includes:

1. Broad spectrum cephalosporins.
2. Tetanus vaccination.
3. Antipyretics and analgesics as needed.
4. Immunoglobulin.

Answer 11

3. Antipyretics and analgesics as needed.

Treatment of mild Bartonella henselae infection includes antipyretics and analgesics as needed. Moderate infection can be treated with azithromycin 500 mg orally on day one, followed by 250 mg orally daily for 4 days. Endocarditis requires antibiotic treatment and consulting with an infectious disease specialist.

Question 12

Co-infection with Hepatitis D can occur with persons who are infected with:

1. Hepatitis C.
2. Hepatitis A.
3. Hepatitis E.
4. Hepatitis B.

Answer 12

4. Hepatitis B.

Co-infection with hepatitis D can occur with persons who are infected with hepatitis B. Hepatitis D (delta virus) needs hepatitis B virus for replication. It can be acute or chronic.

Question 13

Prevention of Hepatitis C includes:

1. Vaccination of HCV.
2. Twin-rix vaccination.
3. Handwashing and avoiding contaminated foods.
4. Not sharing injection drug paraphernalia.

Answer 13

4. Not sharing injection drug paraphernalia.

Prevention of hepatitis C includes not sharing injection drug paraphernalia. Patient education regarding prevention of hepatitis C includes avoiding exposure to HCV-infected blood. The majority of transmission occurs from intravenous drug injection users who share needles and paraphernalia. Approximately 90% of IV drug users will become HCV infected within the first 5 years of use. Sharing toothbrushes, razors, etc. can transmit HCV due to blood exposure. Rarely is HCV transmitted by monogamous sexual partners, but there is higher risk in those with multiple sex partners and those whose sexual practices can cause the tearing of mucosa and exposure to blood.

Question 14

A 28-year-old male comes to the clinic with complaints of watery diarrhea. He states he and his wife just returned from their honeymoon vacation deep-sea diving in Central America. An old wound is noted on his right lower leg. This raises suspicion for:

1. Infectious mononucleosis.
2. Malaria.
3. Vibrio parahaemolyticus.
4. Brucellosis.

Answer 14

3. Vibrio parahaemolyticus.

This strain of Vibrio is not common, but can cause gastrointestinal illness in people, typically self-limiting over 3 days. However, in those with open wounds it can cause infection in the wound. Patients should be evaluated for septicemia, which would require rapid emergency treatment.

Question 15

A 33-year-old female patient with no significant past medical history arrives in the office with complaints of mild respiratory symptoms of cough, fever, and congestion. It is important for the nurse practitioner to be aware that:

1. Patients with respiratory illness require antibacterial treatment most of the time.
2. Patients with these symptoms often require inhaled corticosteroids.
3. Approximately 90% of respiratory illnesses are viral.
4. If the onset is insidious, it is most likely viral.

Answer 15

3. Approximately 90% of respiratory illnesses are viral.

It is important for the nurse practitioner to be aware that approximately 90% of respiratory illnesses are viral. Viral respiratory illnesses typically improve within 7–10 days. If symptoms do not improve, or worsen, evaluation for bacterial infection from the weakened immune system should be initiated.

Question 16

Due to drug resistance in gonococcal infections, which drug is no longer recommended for use in the United States?

1. Ciprofloxacin
2. Ceftriaxone
3. Azithromycin
4. Penicillin

Answer 16

1. Ciprofloxacin

Fluoroquinolones used to be prescribed for gonorrhea; however, due to resistance, the CDC now recommends cephalosporins for treating gonorrhea.

Question 17

Even though there is an effective vaccine, this childhood infectious disease remains one of the leading causes of death in young children. Which of the following is it?

1. Rubeola
2. Varicella
3. Parotitis
4. Erythema infectiosum

Answer 17

1. Rubeola

Rubeola (measles) can have severe complications, including pneumonia, seizures, mental retardation, and death, but is preventable with vaccination.

Question 18

A 23-year-old male patients presents with complaints of “bumps” on his penis. Upon examination, raised lesions, which appear to be genital warts, are noted and a sample is sent for testing that returns positive for HPV. Treatment options include which of the following?

1. Valcyclovir 500 mg bid for 5 days
2. Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks
3. Corticosteroid cream 1% bid after showers for 2 weeks
4. Azithromycin 1 gm orally once

Answer 18

2. Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks

Anogenital warts can spontaneously disappear within one year. Other treatment options include imiquimod, podofilox, sinecatechins, or cryotherapy, surgical removal, and TCA or BCA solutions.

Question 19

Treatment for a positive Chlamydial infection is:

1. Valcyclovir 500 mg bid for 5 days.
2. Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks.
3. Corticosteroid cream 1% bid after showers for 2 weeks.
4. Azithromycin 1 gm orally once.

Answer 19

4. Azithromycin 1 gm orally once.

Chlamydia is most common in persons 24 years of age and younger, and is the most common reportable STD. Other treatment options include doxycycline 100 mg orally twice a day for one week, and levofloxacin 500 mg orally once a day for one week, among other options, as noted in the STD Guidelines recommended by the CDC.

Question 20

Upon visualizing a wet mount for a patient complaining of greenish-colored vaginal discharge, trichomonads with 3 to 6 flagella are noted. Treatment for this patient will include:

1. Valcyclovir 500 mg orally bid for 5 days.
2. Imiquimod 3.75% to affected area once a day at bedtime for 8 weeks.
3. Metronidazole 2 gm orally once.
4. Doxycycline 100 mg orally bid for 7 days.

Answer 20

3. Metronidazole 2 gm orally once.

Trichamoniasis is the most common non-viral STD in the United States. Metronizadole can also be given 500 mg orally twice a day for one week. Tinadazole 2 gm orally once is another option.

Question 21

While infections are the most common cause of fever of unknown origin (FUO) in children, what are the most common causes of FUO in older persons?

1. Neoplasms and connective tissue disorders
2. Endocarditis and HIV
3. Connective tissue disorders and hepatitis
4. Long-term corticosteroid use and COPD

Answer 21

1. Neoplasms and connective tissue disorders

In adults, FUO is defined as a temperature over 38.3°C off and on for over three weeks duration, which has not been adequately diagnosed as an inpatient. Fevers associated with weight loss or other serious signs and symptoms suggest more dire illness, including cancers, HIV, and rheumatic and connective tissue diseases.

Question 22

Persons who have varicella are advised that they may return to school or work:

1. Seventy-two hours after blisters have erupted.
2. Once they no longer have a fever.
3. After 24 hours, as long as they keep the blisters covered tightly.
4. After all the blisters have scabbed over.

Answer 22

4. After all the blisters have scabbed over.

Persons who have varicella are advised that they may return to school or work after all the blisters have scabbed over because they are still considered contagious until this happens.

Question 23

Which patient should be started on opportunistic infection Pneumocystis jiroveci pneumonia prophylaxis?

1. A 52-year-old male with an HIV viral load of 60,000 copies and a CD4 absolute count of 364
2. A 22-year-old female with an HIV viral load of 325,000 copies and a CD4 absolute count of 325
3. A 44-year-old female with an HIV viral load of 1,230 copies and a CD4 absolute count of 185
4. An 18-year-old male with an HIV viral load that is undetectable and a CD4 absolute count of 255

Answer 23

3. A 44-year-old female with an HIV viral load of 1,230 copies and a CD4 absolute count of 185

HIV+ patients whose CD4 cell count falls below 200 cells/mm3 need to start on Bactrim (TMP-SMX) or an alternative (dapsone, Mepron).

Question 24

A 24-year-old female patient asks the nurse practitioner about herpes infections since her new boyfriend told her he might have been exposed to it in a previous relationship. Which of the following statements is not accurate and therefore should not be the nurse practitioner’s response?

1. As long as your partner wears a condom, you do not have to worry about getting genital herpes.
2. You and your partner can be tested for herpes type 1 and type 2 to check if you have been infected, since it could be asymptomatic.
3. There is no cure for herpes infections.
4. Genital herpes can be type 1 and/or type 2.

Answer 24

1. As long as your partner wears a condom, you do not have to worry about getting genital herpes.

Because shedding of HSV can occur outside of the area that condoms cover, they may not be 100% effective.

Question 25

While working in the northeast, a 62-year-old gardener comes to the clinic with complaints of right knee pain and inflammation for a few weeks. Which of the following responses is the best choice to be included in the differential diagnosis?

1. Multiple sclerosis
2. Ankylosing spondylitis
3. Lyme disease
4. Tularemia

Answer 25

3. Lyme disease

This outdoor worker is at high risk for tick bites. Complications from untreated Lyme disease includes joint swelling, effusions, and arthritic symptoms.

Question 26

Patients should be encouraged to do which of the following to keep from becoming infected with West Nile Virus?

1. Wear high socks and sturdy shoes when walking in the woods.
2. Avoid contact with wild rabbits and deer.
3. Apply permethrin onto exposed skin multiple times per day.
4. Use insect repellants and empty outdoor water containers.

Answer 26

4. Use insect repellants and empty outdoor water containers.

Using these techniques can aid in reducing infection from mosquito-borne diseases.

Question 27

“Chandelier’s sign” is associated with which condition?

1. Inflammatory knee pain due to Lyme disease
2. Cervical motion tenderness due to pelvic inflammatory disease
3. A meningeal inflammation sign apparent during neurological examinations of arthritis
4. Optic nerve damage found upon assessment of cranial nerve II

Answer 27

2. Cervical motion tenderness due to pelvic inflammatory disease

During the pelvic examination, severe discomfort causes the patient to reach up toward the ceiling (where chandeliers hang).

Question 28

A patient with a penicillin allergy who needs antibiotics for an infection may safely be given any of the following EXCEPT:

1. TMP-SMX.
2. Doxycycline.
3. Cephalexin.
4. Azithromycin.

Answer 28

3. Cephalexin.

Cross hypersensitivity can occur when using beta lactam antibiotics. Up to 10% can occur, in particular, with first-generation cephalosporins.

Question 29

The nurse practitioner is on-call for the office and speaks by phone to an adult who complains of 48 hours of acute diarrhea consisting of 10 non-bloody loose stools per day. The patient states she has no fever but is asking for antibiotics. She denies any chronic medical diseases and takes no current daily medications. Which of the following is the best initial treatment plan for this patient?

1. Encourage fluids, starches, and loperamide 4 mg initially, then 2 mg after each loose stool (not to exceed 16 mg per day)
2. Flagyl 500 mg by mouth twice a day for 7 days, encourage hydration with electrolyte enhanced water drinks
3. Ciprofloxacin 500 mg by mouth twice a day for 5 days, hydration, loperamide 2 mg (one tablet) every 4 hours (not to exceed 16 mg per day)
4. Probiotics, hydration intravenously, triple antibiotic treatment for suspected parasite infection

Answer 29

1. Encourage fluids, starches, and loperamide 4 mg initially, then 2 mg after each loose stool (not to exceed 16 mg per day)

The best initial treatment plan for this patient is to encourage fluids, starches, and loperamide 4 mg initially, then 2 mg after each loose stool (not to exceed 16 mg per day).

Question 30

A new patient tells the nurse practitioner that he has had a very bad allergy to peanuts in the past and carries an EpiPen wherever he goes. The nurse practitioner educates the patient by reinforcing the need to carry the EpiPen and that anaphylaxis is caused by:

1. Chemicals released into the body system by mast cells and basophils.
2. Mediators from IgG cells that are released into the blood stream.
3. Histamines released into the alveoli by immunoglobulin M.
4. Chemicals released into the major organs by eosinophils.

Answer 30

1. Chemicals released into the body system by mast cells and basophils.

Anaphylaxis is an acute, potentially life-threatening hypersensitivity reaction with the sudden onset of rapidly progressive urticaria and respiratory distress. Signs and symptoms occur between 5–30 minutes after contact with the allergen. Rashes, hives, pruritus, swelling of lips, throat, chest tightness, and a feeling of doom occur, and can be fatal. Treatment with epinephrine and transport to the emergency department is required.

Question 31

Post-exposure to HIV should commence within which timeframe?

1. Less than 72 hours post-exposure
2. Less than 4 days post-exposure
3. Only if it has been less than 48 hours post-exposure
4. Post-exposure treatment can begin within a week post-exposure

Answer 31

3. Only if it has been less than 48 hours post-exposure

Although post-exposure prophylaxis (PEP) will not guarantee that a person will not become infected with HIV, studies have shown that if treatment with the appropriate antiretrovirals is initiated within 72 hours, the risk of infection is significantly reduced. Treatment should continue for 28 days.

Question 32

Complications of tertiary syphilis may include:

1. Seizures and psychosis.
2. Rashes and fevers.
3. Shingles and pneumonia.
4. Respiratory and renal failure.

Answer 32

1. Seizures and psychosis.

Complications of tertiary syphilis may include seizures and psychosis. Untreated syphilis can result in multisystem diseases, including severe neurological issues.

Question 33

Treatment of syphilis in pregnancy must be with:

1. Doxycycline.
2. Metronidazole.
3. Keflex.
4. Penicillin.

Answer 33

4. Penicillin.

Most states require prenatal testing for syphilis to prevent congenital syphilis. Penicillin G is the only known effective treatment. Desensitization by a specialist is required.

Question 34

A 64-year-old patient comes to the office and states she found a tick on her abdomen a week or two ago which seemed engorged but she pulled it out and threw it in the garbage. She now has a circular rash that has the typical bull’s-eye appearance. Treatment for this patient would be:

1. Azithromycin 500 mg orally for 3 days.
2. Keflex 500 mg orally for 7 days.
3. Doxycycline 100 mg orally for 7 days.
4. Ceftriaxone 1 gm IV daily for 3 days.

Answer 34

4. Ceftriaxone 1 gm IV daily for 3 days.

If the patient had come to be seen immediately after noticing the engorged tick bite, a prophylactic one-time dose of doxycycline can be offered.

Question 35

Vaccinations for HPV are:

1. The same for males and females.
2. Only indicated for females.
3. Different in age ranges for men who have sex with men.
4. Not indicated once the patient is 18 years of age.

Answer 35

4. Not indicated once the patient is 18 years of age.

Vaccinations are indicated for 11–12 years through 26 years of age.

Question 36

The minimum inhibitory concentration (MIC) is important, because it indicates:

1. The lowest dose of an antibiotic that is needed.
2. The lowest concentration of an antimicrobial agent required to kill an organism.
3. The smallest measurement of sensitivity of resistance.
4. The method used to measure the peak dose of an antibiotic’s effect.

Answer 36

2. The lowest concentration of an antimicrobial agent required to kill an organism.

The minimum inhibitory concentration (MIC) is important because it indicates the lowest concentration of an antimicrobial agent required to kill an organism.

Question 37

What is the most commonly reported STD in the teenage and early adulthood years?

1. HSV
2. Syphilis
3. Chlamydia
4. Babesiosis

Answer 37

3. Chlamydia

Highest in those 24 years of age and younger, Chlamydia should be a part of screening for sexually active young people, and those 25 years and older with risk factors.

Question 38

A patient presents to the NP’s office and states that there was a deer tick crawling on her one month ago. She was sick with a cold recently and is concerned that perhaps she has contracted Lyme disease. The NP gets the following results from the serology studies: Lyme AB screen: 1.38 (a positive Lyme antibody screen is > or = to 1.10). A Western blot IGG and IGM is done. All bands are negative or non-reactive. The PCP correctly offers the following information:

1. The patient has Lyme disease and should begin 21 days of therapy with doxycycline 100 mg bid.
2. The patient does not have Lyme disease. No therapy is warranted.
3. The patient has chronic Lyme disease and will need IV antibiotic therapy for 2–3 months.
4. The patient should be treated prophylactically with a one-time dose of oral doxycycline.

Answer 38

2. The patient does not have Lyme disease. No therapy is warranted.

The patient does not have Lyme disease, so no therapy is needed. The appropriate Western blot bands are required to qualify as a positive result. No positive or reactive bands means a negative result. In addition, the complaints of a cold are not consistent with more common symptoms of Lyme infection.

Question 39

All of the following statements regarding MRSA are true except:

1. MRSA can be necrotizing to tissues.
2. The transmission of MRSA infections can be reduced with good hand washing technique.
3. MRSA is often transmitted from person to person during contact sports.
4. Community-acquired MRSA is known to be more virulent than hospital-acquired MRSA.

Answer 39

4. Community-acquired MRSA is known to be more virulent than hospital-acquired MRSA.

The genotype of the organisms varies and either community- or hospital-acquired MRSA can be more contagious and virulent depending on the particular organism.

Question 40

The NP encounters a patient who is complaining of fever, headache, nausea, vomiting, cough, chills, and chest pain. The patient is hospitalized and is found to have multilobar pneumonia due to a legionella infection. Which of the following teaching points is important for both the patient and the hospital staff?

1. The patient should be placed on respiratory isolation with airborne precautions.
2. The patient should be placed on contact and droplet precautions.
3. Once symptoms appear, the patient is no longer contagious.
4. Legionella is not transmitted from person to person.

Answer 40

4. Legionella is not transmitted from person to person.

Legionella is not transmitted from person to person. Transmission occurs when water mist or vapor contaminated with the bacteria is ingested.

Question 41

The most common neurologic manifestation of Lyme disease is:

1. Meningitis.
2. Bell’s palsy
3. Guillain–Barré syndrome.
4. Peripheral neuropathy.

Answer 41

2. Bell’s palsy

The most common neurologic manifestation of Lyme disease is Bell’s palsy.

Question 42

A 17-year-old female comes in to the clinic with a chief complaint of vaginal discharge. Upon questioning, she says she has a new sexual partner and they often do not use condoms. The discharge is yellowish and the patient complains of dysuria. The nucleic acid amplification test (NAAT) is positive for Chlamydia. The nurse practitioner writes a prescription for which of the following medications?

1. Flagyl 2 gm orally once
2. Keflex 500 mg orally once
3. Zithromax 1 gm orally once
4. Levaquin 500 mg orally once

Answer 42

3. Zithromax 1 gm orally once

Zithromax, also known as azithromycin, is the proper medication to prescribe. The nurse practitioner should also educate the patient to refreain from sexual intercourse for one week after treatment.

Question 43

The nurse practitioner is aware that patient education is an important part of treating STDs. When treating a patient who has a positive Chlamydia test, which of the following statements should be discussed in addition to telling the patient that the sexual partner(s) should be treated as well? Choose the best answer.

1. It is important that you abstain from sexual intercourse for 7 days and until your partner has gotten treated.
2. It is not risky to have intercourse as long as your partner wears a condom.
3. Once you have had Chlamydia, it is not possible to get re-infected.
4. Getting tested for other STDs is not necessary once the medication has been taken.

Answer 43

1. It is important that you abstain from sexual intercourse for 7 days and until your partner has gotten treated.

Reinfection can occur if both partners are not treated appropriately. The patient should be counseled on the benefits of condom use in decreasing the risk of STD acquisition.

Question 44

For females, it is imperative to get tested and treated for STDs. Patient education should include which of the following? Choose the best answer.

1. Sexually transmitted diseases in adolescents indicate a need for more parental supervision.
2. Having Chlamydia or gonorrhea will cause difficulty when the patient is trying to conceive.
3. Having an STD can cause pelvic inflammatory disease, which can cause infertility.
4. Using sex “toys” will prevent the spread of STDs.

Answer 44

3. Having an STD can cause pelvic inflammatory disease, which can cause infertility.

Having an STD can cause pelvic inflammatory disease, which can cause infertility. Even subclinical PID can cause infertility; therefore, it is imperative to screen those at risk for STDs.

Question 45

A bacteriostatic antibiotic can:

1. Kill bacteria independent of the immune system.
2. Inhibit the replication of bacteria.
3. Typically cause diarrhea.
4. Prevent mutations and resistance of a drug.

Answer 45

2. Inhibit the replication of bacteria.

A bacteriostatic antibiotic inhibits cell wall synthesis and works to alter permeability and cause leakage of intracellular compounds.

Question 46

Most gram-negative rods:

1. Live and replicate outside the cell.
2. Live within the DNA of the cell.
3. Do not cause illness.
4. Are rarely resistant to medications.

Answer 46

1. Live and replicate outside the cell.

Most gram-negative rods live and replicate outside the cell. Treat these only if a bacterial infection is present.

Question 47

An HIV-infected patient gets a diagnosis of AIDS when the CD4 cell count is below which of the following?

1. 250 cells/mm3
2. 350 cells/mm3
3. 500 cells/mm3
4. 200 cells/mm3

Answer 47

4. 200 cells/mm3

An AIDS diagnosis is given when a patient has a low CD4 cell count (200 or less), and/or an AIDS defining condition, and/or CD4 cells are less than 14% of all lymphocytes.

Question 48

One option for decreasing an MRSA wound infection in a patient who has colonized MRSA and is scheduled for surgery is:

1. Intravenous vancomycin daily for 3 days pre-operatively.
2. There is no effective pre-treatment to decrease the wound infection.
3. Applying Bactroban (mupirocin) nasally twice a day for 5 days pre-op.
4. Routine screening during yearly physical examinations.

Answer 48

3. Applying Bactroban (mupirocin) nasally twice a day for 5 days pre-op.

Studies have shown a decrease in complications related to MRSA when patients are screened and treated pre-operatively.